Primary Care Docs the Leading Prescribers of Narcotic Painkillers

Americans continue to be plagued by an epidemic of prescription narcotic painkiller abuse, and a new study finds primary care physicians (PCP) are by far the biggest prescribers of the drugs.

Researchers led by Dr. Jonathan Chen, of Stanford University, looked at data from 2013 Medicare Part D prescription drug coverage claims.  They focused on prescriptions for narcotic painkillers containing hydrocodone (like Vicodin), oxycodone (Oxycontin and Percocet), codeine and others in this class, known as opioids.

In sheer number of prescriptions written, the largest prescribers were PCPs.  Family practice doctors issued 15.3 million prescriptions, while internal medicine physicians issued 12.8 million, the researchers found.

The study also found nurse practitioners wrote 4.1 million prescriptions for narcotic painkillers while physician assistants ordered up 3.1 million.

Based on claims-per-prescriber, pain specialists led the way, followed by those in pain management, anesthesiology and physical medicine and rehabilitation, the researchers said.

There’s been a 10—fold increase in the abuse of narcotic painkillers in the United States over the past two decades, Chen noted in a Stanford news release.  Some experts have  suggested that small groups of high-volume prescribers and so-called “pill mills” are the main reasons for the narcotic painkiller overdose epidemic in the United States.

However, Chen’s team now believes that “high-volume prescribers are not alone responsible for the high national volume of opioid prescriptions,” and “efforts to curtain national opioid overprescribing must address a broad swath of prescribers to be effective.”



Doctors and other health care professionals need better eduction on proper prescribing of these painkillers, “starting very early in the process,” said Victoria Richards, an associate professor of medical sciences at Quinnipiac University School of Medicine, in Hamden, Conn.  And, there needs to be “increased oversight, follow-up and accountability in prescribing and patient care - including increased patient/community education and awareness.”

This study was published online Dec. 14 in the journal JAMA Internal Medicine.

My Take:
I have a hard time understanding how any primary care physician can need better education on proper prescribing of these painkillers.  In the state of Florida, I am licensed as a primary care physician.  I understand the dangers associated with this class of drugs even though I am not licensed to prescribe them.  My curriculum in chiropractic college did not cover prescribing drugs.  However, I familiarize myself with every medication my patients list on the intake history.  How could you possibly write a script for a opioid and not be acutely aware of the addictive potential of these narcotics?

The Bottom Line:
I guess the patient must become educated as the primary care physicians writing the scripts don’t appear to understand the ramifications of their actions.

Source: December 14, 2015 National Institutes of Health